Provider Demographics
NPI:1043481948
Name:HALLIBURTON, KATIE ELIZABETH (PT)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:HALLIBURTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ELIZABETH
Other - Last Name:FELTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1528 E COMMON ST
Mailing Address - Street 2:STE 23
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3337
Mailing Address - Country:US
Mailing Address - Phone:830-620-4922
Mailing Address - Fax:830-625-1194
Practice Address - Street 1:1528 E COMMON ST
Practice Address - Street 2:STE 23
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3337
Practice Address - Country:US
Practice Address - Phone:830-620-4922
Practice Address - Fax:830-625-1194
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1170340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1170340OtherPT LICENSE